Mikelle Moore: 00:07 Hi. I'm Mikelle Moore. I'm senior vice president of community health for Intermountain Healthcare, and I have the pleasure of being here with Mayor Tubbs from Stockton, California.

I'd love for you to tell us a little bit about yourself, Mayor Tubbs, and let us get to know one another for a moment because I think at the outset, the relationship between Stockton and Salt Lake City isn't probably intuitive.

Michael Tubbs: 00:32 Absolutely. Well, thanks much for having me. Again, as you said, my name's Michael Tubbs. I'm currently the mayor of Stockton, born and raised in Stockton. So Stockton's home. Grew up living with a lot of the issues that I work on as mayor. Grew up in poverty. My mom, she had me while in high school, and my father's still been incarcerated. So a lot of the issues we work on in Stockton, whether it's poverty or increasing opportunity or education or the social determinants of health, aren't just things I studied at Stanford but things I actually lived.

While growing up, I was blessed to have almost a village of folks from my mother, my grandmother, my aunt, who were not perfect people but very adamant about having me understand that there's no limits, that I have to create opportunity, and that education would probably be the best lever or my way out. So I was able to graduate high school, was able to go to Stanford for four years, where I did my master's and bachelor's, and there, I became really interested in policy.

Up to that point, I was really focused on just the things I could control as a teenager, which were my choices. But then when I got to college, I realized that there's a whole policy world where people are making choices that create the environments that people live in. And I thought, "Wow, I would love to be part of that world." So I interned at Google for three months. Loved it. So I thought I'd end up there. Interned in the White House working on mayors and councils and doing research and tours for them, and actually didn't enjoy it that much, which is hilarious. I didn't enjoy it at all.

But then I realized that at a local level, folks were making a big difference and impact. And then while there, unfortunately, one of my cousins was a victim in the spike in homicides in Stockton, and that's what drove me home. So I ran for city council, did that for four years, ran for mayor. And the past two-and-a-half years, we've made significant progress. Still a long way to go, but homicides were down 40% last year, which I'm incredibly proud of.

Mikelle Moore: 02:25 Impressive. Really impressive.

Michael Tubbs: 02:28 All credit goes to the community, from the police department to our community-based organizations to our strategy ceasefires and [inaudible 00:02:35]. But in terms of who I am, to answer your question, I think I'm just a person who's really motivated by this idea that there's so much waste in terms of the talent people have. As a former educator, I would get frustrated with some of my students who were brilliant and wouldn't perform or had all these barriers to performance.

So I'm really just a normal guy who really believes that we can do a lot better as communities in creating the environments where people can make good choices.

Mikelle Moore: 03:06 I love that. And while we have very different backgrounds, I think we've arrived at things in a similar place. I have an uncle who's from Stockton-

Michael Tubbs: 03:16 Really?

Mikelle Moore: 03:16 ... lives in Stockton. He was the only person in my family who had any link to the medical community, and I thought ... I actually admired him greatly and thought I wanted to be a physician. Long story short, I decided I ... Like you in the White House, I did not like volunteering in a hospital and actually caring for patients individually.

So I went into health administration and found myself as a hospital CEO here in The Avenues part of Salt Lake. In that hospital, we did a lot of really high-end things, liver transplants and open-heart surgery. And yet when that hospital changed and became a community hospital, I began to really notice the people who were coming in the emergency department sometimes nearly every day or at least every week. While we were helping them in the moment, we were taking care of their needs, giving them a warm meal, a warm blanket, and a place to stay and recover for a moment. They went back to the community into the same challenges they were facing only to come back just a couple of days later.
I thought there has to be something better. So that's how I find myself in this work.

Michael Tubbs: 04:34 Well, that definitely resonates.

Mikelle Moore: 04:36 Good, good. I thought it would. Well, we heard at the conference we're both attending here, the Sorenson Impact Summit, that the opportunity zones that exist all across our country are a place where impact investors, people like you, people like me, can come together to make a difference in improving health, well-being, livelihood for people. What are you doing in Stockton that resonates for you most in creating opportunity for the people in your community?

Michael Tubbs: 05:09 Well, in Stockton, we're excited about opportunity zones. But we've been very clear and focused that the primary folks ... that the focus opportunity zones has to be not in the zone as a place but in the people who make it a place. So we're really thinking about, how do we drive investments to the needs of the community?
Luckily for us, our entire downtown is an opportunity zone, including our waterfront, which gives us the chance to do great things, whether it's affordable housing and market-rate housing, live/work spaces, expanding entrepreneurship in our downtown. And we're just super excited about the chance to leverage this tool, but this tool in a way that's not divorced from community aspirations but it gives life to community aspirations.

So even before opportunity zones, we have been talking to the community to get a sense for some of the things they needed in terms of health clinics, in terms of grocery stores, in terms of real economic opportunity and jobs. Now this opportunity zone gives us the added tool of capital to make some of those aspirations come true for our community. So I'm very, very excited.

Mikelle Moore: 06:13 Do you have any real examples yet of how a need you identified and heard from the community is now being made possible through the availability of capital?

Michael Tubbs: 06:25 Well, I think we're getting there. There's a couple of organizations or workforce type of investments, one named [Console 00:06:32] and one ... It's like a co-op, workers' co-op sort of coworking space. Both of those are now thinking about moving into downtown Stockton because it's an opportunity zone. For me, it's important because our folks have been saying, "We want jobs. We want access to economic opportunity. We want the chance to be part of this new economy."

And then, also in our downtown area, there's a huge need for housing in Stockton, especially housing that folks in Stockton could actually afford. We're talking to some people now about funding some of our projects that are already in the works in our opportunity zone downtown but also some projects that are on our waterfront, which, again, would make community aspirations possible because people have been saying, "We want housing. We want housing. We need housing." Now we have capital that can make that happen.

Mikelle Moore: 07:24 What is the link that you've seen between housing and employment and well-being?

Michael Tubbs: 07:31 Six years ago or seven years ago, when I was on city council, we created this collective impact approach. As a educator, I always went to education. And public safety was just so in my face, and we had a couple members of the steering committee who were housing developers. They would always say, "You're always forgetting about housing. You're always forgetting about housing. Housing is fundamental. Housing is fundamental."

To be honest, I think I heard them, but I was like, "That's what they're supposed to say. That's what they do every day." But over the past five, six years, I understand what they've been saying in terms of housing being stable. When I think about the strategy we're trying to employ in Stockton based off the work done in Salt Lake City around Housing First and that housing allows folks to stabilize. Not the panacea, but it is a floor upon which you can build and layer things like education and things like health care delivery, etc.

So I'm now a believer that housing is foundational. It has to be at the bedrock of any kind of strategy for community improvement.

Mikelle Moore: 08:34 Yeah. I really agree with you. I think we learn over and over again in health care that if we provide someone with treatment but they go home to not have a safe place to recover or a place to store their insulin in a refrigerator, what good is the health care that we're providing? We've got to follow Maslow's hierarchy, right? Safety first, and only then can we help people advance further.

In the realm of politics, you've done some really great things. Do you see that policy and politics is the way to have the greatest impact?

Michael Tubbs: 09:13 Yes and no. I think, for me, I'm attracted to policy because I think that's the only thing that touches everybody at scale. An ordinance, a rule, everyone has to follow it. It's the law of the land. But I'm also beginning to understand now that policy in and of itself, divorced from practitioner experience, for example, or divorced from the insights from program administrators, is anemic and doesn't really get anything done.

But I also struggle with ... A lot of my friends are social entrepreneurs and do amazing things. But I think a lot of them are social entrepreneurs because they don't want to engage in the messiness of politics because you're not acting unilaterally. You're acting in the context of people who have very different beliefs about the causes and even about, sometimes, the baseline facts.

But, again, for me, I think I come from politics from the realization understanding that those who are the most marginalized, those who are [clinical delecities 00:10:11] in our society, those are the folks that can't opt out of government. They can't send their kids to private schools. They really rely on the public good. For me, that's what makes policy so important to me, because it's good for everyone but particularly for those who are the most marginalized. It's very, very part and parcel to even how they are able to enjoy and live as citizens.

Mikelle Moore: 10:41 What have you found is important to bring different perspectives together? You described something that I think is very much going on in our country right now. We can all see the issues, but we might come to our understanding from a really different perspective. How do you bring people together so that the solutions work for the people in our communities?

Michael Tubbs: 11:06 Well, what's amazing, and it's a special blessing, I would say, is that Stockton is so ideologically diverse. For example, my council is three republicans, three democrats, and me. So every day-

Mikelle Moore: 11:23 Every day, you're living this.

Michael Tubbs: 11:23 ... every meeting, every conversation, it's what we have to have. And I would say what I've found is that, to your point, when we focus on not just a problem ... We focus on, do we all agree this is a problem? And then where are some solutions? Let's try and mount. We get to, most of the times, a good place.

For example, I'm incredibly proud that our council unanimously said affordable housing is a top priority. Sometimes affordable housing, people get-

Mikelle Moore: 11:52 That can be a lightning rod, can't it? Yes.

Michael Tubbs: 11:53 Right. But the entire council, from the most affluent areas to the most disenfranchised areas, I think affordable housing should be our top priority. But, again, I think it goes to a focus not just on dialogue and disagreement for disagreement's sake, but say, "We're going to put our thumbs on the table, our perspectives on the table, but the goal is to get ... We can't just stay ... We have to get somewhere," and understanding that we won't get to a perfect place for everyone. But if we get to a place where there's a solution for the people we serve, then we can all live with that.

It's not a perfect process, but I think it's been successful, and it's caused me to flex my muscles and my listening muscles and how to listen to people and understand their interest and give them ...

Mikelle Moore: 12:39 You mentioned earlier using a collective impact approach. Have you taken a collective impact approach in Stockton to help define that common goal and put metrics in front of people and create that momentum?

Michael Tubbs: 12:56 We haven't done it as well citywide yet, but a lot of our collective impact work is centered on my old council district. We started a process through a organization called Reinvent South Stockton Coalition, buffered by the Promise Zone Initiative of the previous administration. Looking at around health, housing, public safety, education, and neighborhood transformation, what are the three results we want to see, and what are the three indicators we're going to track to help get us there?

It's been a messy, messy process. We have to restart sometimes, every few terms. But I appreciate ... because we've gotten to a point now where there's goals. Whether we're reaching them or not is another story, but at least we have something to hold ourselves accountable, so in terms of how many kids we want reading at grade level by third grade, and how do we know we did it? How many people do we want to have in homes, and how do we know we did it? How much do we want to reduce violent crime by, and how do we know that we did it?

So that's been incredibly helpful, and I think it's taught me a proverb that [Cindy Booker 00:13:57] usually says, that if you want to go fast, you should go by yourself. But if you want to go far, you have to go together.

Mikelle Moore: 14:03 You have to go together.

Michael Tubbs: 14:04 So I'm practicing going far. Even though it's frustrating sometimes, I've seen the impact in how a lot of these things are ... A lot of things are happening. Maybe not at the speed I want them to happen, but they're happening, and they're going to happen in a sustainable manner because everyone's bought in, especially the people who aren't [inaudible 00:14:23], who don't have a window of time with which to be in their position but who are going to be there 10, 20 years after I'm done.

Mikelle Moore: 14:30 I commend you for sticking to the going far. Here in Salt Lake, we've had a number of things going on in a collective impact approach around trying to address homelessness. We've taken that approach on some of our efforts that we've convened as a health system around the opioid epidemic and now suicide prevention. It is slower. It is messy, and it's worth it because I think that's how you get long-standing impact.

I'd love to ask you a kind of broad question. I realize you and I are in really different fields, in a way, and yet the issues that we're talking about are very real to both of us. I am a part of a health system that employs about 37,000 people across the state. We have 24 hospitals across the state. In every community where we operate, we're the largest employer other than government. We're the largest private employer.

We think a lot about the direct health care we deliver to people and the impact that has on well-being. We're also beginning to think about the way we employ people, the opportunities we can create both at the entry level and as people have the opportunity to advance in their career, and we're also beginning to think about the investments we can make. What social opportunity can we create by taking our investments and applying them locally rather than putting them with a global investment fund?

What would your advice to us be? Knowing what you know from Stockton, how can we have the greatest impact on health and well-being here in Utah?

Michael Tubbs: 16:16 It's funny. I was smiling because our biggest employers outside of government are our health care partners, and we've been having a lot of conversations with them about how to even further amplify and impact their work.

Mikelle Moore: 16:28 Good.

Michael Tubbs: 16:30 I think we've been looking at things like procurement policies, like how do you make sure that when we're buying things as simple as toilet paper or doing things as complex as IT, that there's some local folks part of that mix? I think on the employment side, we're working now ... There's a group called HealthForce Partners of all our hospitals who are looking at, how do they really partner with our school district to create clear pipelines for kids to be in the medical field-

Mikelle Moore: 16:52 Great.

Michael Tubbs: 16:52 ... whether it's a doctor or a nurse, medical assistant, data scientist, etc.? So really proud of that work, and I think also just leveraging the bully pulpit you all have, especially because you guys aren't political-

Mikelle Moore: 17:06 It's true.

Michael Tubbs: 17:07 ... to really talk about, whether you're right or left, this is the problem. And this is our stake in the game. This is what we're ready to put in. So I think, oftentimes, I've seen my colleagues move faster if the head of the hospital comes out and says, "Homelessness in our communities, unacceptable. We're going to put this many dollars to this solution. We need government to match us." You could incentivize and garner action, and I think just even being mindful in thinking that, as you know ... because health touches everything.

Mikelle Moore: 17:37 It does.

Michael Tubbs: 17:38 So even being mindful and thoughtful around, "Okay, what are some of the things ..." And, also, you guys are like the barometer because the things you see in the emergency room really highlight community-wide dysfunctions, or the things your employees, excuse me, are facing, whether it's commute times or housing affordability, etc., you could help inform government practice.

So I think it's one thing to hear from the 10 people who come to council meetings and oftentimes come all the time. It's another thing to hear from the hospitals [inaudible 00:18:08] affordable housing. I think that has the potential to garner more action and more attention, like, "Oh, wow. If this is a group, a company, a system I wouldn't expect to care about this issue or know about this issue [inaudible 00:18:22], maybe this really is a problem."

Mikelle Moore: 18:24 I really appreciate that advice. And our intent is to use it. We're really thinking about the role that we can have in this community to improve health. Providing the highest-quality health care will always be our job, number one. And yet the way we do that is with a large team of caregivers that are living life every day as employees, as homeowners, or not. And we've got to think about how we connect in all of those ways to support people.

Michael Tubbs: 19:00 Well, it's funny. While we were talking, I was thinking, "When I get home, I need to convene all my hospital folks and have another meeting around homelessness and housing and get them to further buy in and be partners. So thank you.

Mikelle Moore: 19:16 Absolutely. We know there's a link. If someone is homeless, they are between five and eight times as likely to use the emergency department compared to if they're not. So it really is something that ... I think you're right. We can see the problem in our emergency rooms if we pay attention to what the root issue is and be a part of the solution. So I hope you do go back and talk to your hospital partners-

Mikelle Moore: 19:47 Mayor Tubbs, it's been such a pleasure getting to know you. And if I may, Michael-

Michael Tubbs: 19:51 Yeah, Michael's perfect.

Mikelle Moore: 19:53 ... it's been a pleasure getting to know you. For those who are listening, they can't maybe get a sense of all the passion and energy that you bring to this work. I encourage them to go and learn about you, learn about you further. But what advice would you give to people who are young, maybe like yourself, who have aspirations to change the world?

Michael Tubbs: 20:19 I would say, number one, one of my grandma's favorite scriptures is, "Don't get weary in well-doing, for in due season, you'll reap a harvest if you faint not," meaning tomorrow the big change is just actually a bunch of little things that happen day after day, day after day. When you're the most tired, that's oftentimes when you're closest to getting to that solution or getting to that breakthrough. So just staying the course. Being fatigued is normal, or even being scared sometimes is normal, but not letting that be the only emotion and not ... Feeling that and acknowledging that and moving forward anyway.

Then I would also say that leadership is not necessarily being ... Even though we make our leaders speak all the time, leadership is not really about being in the microphone. Some of the best leaders I know are the folks that make sure everyone has water or the folks that make sure the doors are unlocked. There's a lot of ways to serve and lead, and if you're mindful of the impactful you want to make, that no matter who recognizes you or who sees you or what your title is, if you focus on the work, then good things will happen.

Mikelle Moore: 21:25 Great advice. Thank you, Michael.

Michael Tubbs: 21:25 Thank you.

Mikelle Moore: 21:27 It's been a pleasure to get to know you better.

Michael Tubbs: 21:29 Well, thanks for having me. For more information about the work we're doing in Stockton or to follow my lively Twitter feed, just go to @michaeldtubbs or michaeldtubbs.com.

Mikelle Moore: 21:40 For more information about Intermountain Healthcare and our work to improve health and well-being here in Utah, please go to intermountain.health.

This has been a podcast with Intermountain Healthcare and Mayor Michael Tubbs and Mikelle Moore. It's been a pleasure having you.

Intermountain Healthcare is a Utah-based, not-for-profit system of 24 hospitals (includes "virtual" hospital), a Medical Group with more than 2,400 physicians and advanced practice clinicians at about 160 clinics, a health plans division called SelectHealth, and other health services. Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and efficient healthcare delivery.